Post-sirolimus-eluting stent restenosis treated with repeat percutaneous intervention: late angiographic and clinical outcomes.
BACKGROUND: We evaluated the clinical and angiographic outcomes of patients presenting with restenosis after sirolimus-eluting stent (SES) implantation treated with repeated percutaneous intervention. METHODS AND RESULTS: A total of 24 consecutive patients have undergone repeated percutaneous intervention to treat post-SES restenosis (27 lesions). The restenosis was located within the stent in 93% of lesions. From the 27 lesions, 1 (4%) was re-treated with a bare stent, 3 (11%) were treated with balloon dilatation, and the remaining 23 lesions (85%) were treated with repeated drug-eluting stent implantation (SES in 12 lesions [44%], paclitaxel-eluting stents in 11 lesions [41%]). The event-free survival rate was 70.8% after a median follow-up of 279 days from the post-SES treatment. The overall recurrent restenosis rate was 42.9%. The risk of recurrent restenosis was increased for patients with hypercholesterolemia, previous angioplasty, failed brachytherapy, post-SES restenosis needing early (<6 months) treatment, and post-SES restenosis treated with balloon dilatation. The recurrent restenosis rate of originally de novo lesions re-treated with drug-eluting stents was 18.2%. CONCLUSIONS: Even though de novo lesions treated with SES at baseline and re-treated with drug-eluting stents had reasonably better outcomes than other lesion types and strategies, our study shows that the treatment of post-SES restenosis is currently suboptimal and warrants further investigation.
|Keywords||*Angioplasty, Transluminal, Percutaneous Coronary, *Stents, Aged, Brachytherapy, Cohort Studies, Combined Modality Therapy, Coronary Restenosis/epidemiology/radiography/*therapy, Coronary Stenosis/drug therapy/radiotherapy/therapy, Disease-Free Survival, Drug Implants, Female, Follow-Up Studies, Humans, Hypercholesterolemia/complications, Incidence, Male, Middle aged, Paclitaxel/administration & dosage/therapeutic use, Recurrence, Research Support, Non-U.S. Gov't, Sirolimus/administration & dosage/*therapeutic use, Treatment Outcome|
|Note||Epub 2004 May 17|
|Persistent URL||dx.doi.org/10.1161/01.CIR.0000130173.63105.4E, hdl.handle.net/1765/13380|
Lemos, P.A., van Mieghem, C.A.G., Arampatzis, C.A., Hoye, A., Ong, A.T.L., McFadden, E.P., … Serruys, P.W.J.C.. (2004). Post-sirolimus-eluting stent restenosis treated with repeat percutaneous intervention: late angiographic and clinical outcomes.. Circulation (Baltimore), 109(21), 2500–2502. doi:10.1161/01.CIR.0000130173.63105.4E